Dr. Timothy Kremchek
The New Hipsters
FROM JOHNNY BENCH TO PRINCE, BOOMERS

MOVE AHEAD WITH ARTIFICIAL JOINTS
Longtime Reds fans remember Johnny Bench as the strong, seemingly invincible catcher behind the plate, the 12-time National League All-Star sending signs to the pitcher. But by 2004, the then 56-year-old baseball Hall of Famer was a shadow of his former self physically. His body was the one sending signals. For years, Bench says, every step brought pain. Getting out of bed was torture. Even turning over in bed brought a shock wave of pain.

“I went through all sorts of tests to diagnose what was wrong,” Bench says. “It felt like the worst groin pull you’ve ever had. Your knees can hurt, your back hurts. I’ve had broken bones, shoulder problems and knees, so I knew pain. This was something different.

“I went through a couple of diagnoses,” Bench recalls, “then there I am playing golf and my friend, a doctor, sees me walk up to tee off and says ‘Hey, Johnny, you’re hip’s gone’.” Tests proved that 17-year Major League career, crouching in a catcher’s stance, had worn down the Reds legend’s right hip, with each small movement grinding bone against bone. Later that year, doctors replaced it with a metal and ceramic implant, forever changing Bench’s life. The surgery, called hip arthroplasty, involves the removal of the ball and socket of the arthritic or otherwise damaged hip joint that has lost natural, frictionless movement.

After the top part of the femur (the thigh bone) is removed, the implant fits within the central canal of the femur. Cartilage and bone are also removed from the socket part of the joint within the hip, and doctors build a new socket in its place.

“It’s amazing how much better my life is,” says Bench, who now makes appearances nationwide with panels of doctors, answering prospective patients’ questions about the surgery. “I’ve got a 2-year-old son that I can pick up and hold now. There was no way I could have even thought of that before I had the hip done.”

The American Medical Association reports more than 350,000 hip replacements were done last year — a sharp increase in 10 years, and mostly among those in the 40 to 60 age range. As more baby boomers begin experiencing forms of osteoarthritis, they’re seeking hip replacement to continue active lifestyles.

Indeed, the procedure has become, well, almost hip. Duke University basketball coach Mike Krzyzewski was 55 by the time he had his second hip replacement in 2002. Pop performer Prince, age 48, is currently rehabilitating with a new hip. Rocker Eddie Van Halen was only 44 when he had his replaced eight years ago.

“Not long ago, if a patient came to you with pain from a damaged joint, the solution was to limit their activity,” recalls Dr. Tim Kremchek, the Reds’ team medical director and an orthopedic surgeon with Beacon Orthopaedics and Sports Medicine. “Don’t jog, don’t play tennis, don’t live your life as you have. Now, we’re practicing more of what I call ‘the art of medicine.’ We take into account what the patients want, as far as their lifestyles. Boomers want to remain active.”

Kremchek and other Tristate specialists in orthopedics and sports medicine say advancements in implant technology and improved surgical practices are a driving force in this trend. Because implants were once expected to last only 10 to 15 years, doctors would postpone surgery until patients were in their 60s or 70s, hoping the procedure wouldn’t have to be repeated. The newest implants are lasting longer, and people don’t want to suffer for years through pain and limited activity in what could be the prime of their lives.

“The mindset has changed,” Kremchek explains. “If you’re an active 45 year old, and you have that kind of pain, why would you want to wait 15 years to have something done?”

Dr. Michael Swank, medical director of Freiberg Orthopaedics & Sports Medicine, notes other factors come into play. Doctors now are seeing the long-term effects of high-activity, body-stressing youth sports, he notes. The rising rate of obesity is taking a higher toll on joints, too. The orthopedic surgeon says federal data indicates that a normal-weight person who lives to 80 has about a 10 percent chance of having osteoarthritis of the hip, while about 40 percent of overweight people who reach that age will suffer arthritic hip problems and pain.

“I think society’s views have changed a little bit,” Swank adds. “People are more likely now to seek treatment early.”

Implant science has added significantly to the trend, says Dr. Tom Lindenfeld of the Cincinnati Sportsmedicine and Orthopaedic Center. New technologies make implants better and stronger than ever before. Lindenfeld says new designs include a larger ball in the socket, giving patients a greater range of movement after rehabilitation and less chance of dislocating the new joint with daily activity. Advanced alloys, plastics and ceramics are making artificial hips work better and last longer.

“Most of the metals in implants are the same metals that have been used for 30 years, but the metallurgy is better, the milling is better, and there’s less of a chance for problems in the future that we have to revisit surgically,” Lindenfeld explains.

Three types of implants are prevalent: metal-to-metal joints, a joint that includes ceramic parts that mimic natural bone, and hybrids that use advanced plastics and metals, such as oxidized zirconium. Current studies report that 90 percent of hip implants are lasting longer than 15 years, and 75 percent of implants are lasting at least 20 years, Lindenfeld says.

“And that’s all from 20-year-old technology, because patients have to have had the implants long enough for us to gauge that information,” the doctor adds. “Since today’s implants are clearly better, it’s entirely possible that we’ll see them last 30 to 35 years.”

Surgical techniques and prevailing views on physical rehabilitation also have evolved, cutting the time from first incision to complete recovery.

The typical surgical procedure lasts about two hours on the operating table. As in other surgical fields, orthopedic specialists debate the merits of “open” versus minimally invasive (MI) operations. Traditional total hip replacement involves a 5-to-8 inch incision, which allows the surgeon to separate the muscles surrounding the joint and see the entire hip anatomy. “Mini” hip replacement is performed with two smaller incisions and less muscle dissection.

Proponents say minimally invasive surgery means less blood loss, less pain and a quicker rehabilitation. But critics say the use of endoscopic cameras or medical imaging to perform the operation can limit the surgeon’s visualization of the interior anatomy.

“The latest studies say the two-incision method just isn’t worth it,” Lindenfeld remarks. “There’s the risk of dislocation and other problems if the implants aren’t positioned properly, which is less of a problem if you can see the entire field.”

Swank views it differently. “I weigh in on MI. Why wouldn’t you want to have less tissue damage?” He was one of the first local surgeons to employ a computerized navigation system for joint replacement, which enhances his surgical visualization, Swank says. “I see things greater than I could with my own eyes.”

According to current rsearch, the two hip surgery techniques result in nearly identical rehabilitation time. Patients typically are encouraged to stand the day following surgery, and most are back home within four days. They usually can walk with a cane or walker for a couple of weeks, then resume normal activities within two months.

An option to total joint replacement is hip resurfacing, a procedure approved by the U.S. Food and Drug Administration two years ago. Swank compares resurfacing to getting a dental crown, when part of the tooth and root remain. Total knee replacement is like a dental implant that replaces the entire tooth as a seat for the crown, he explains. Swanks says there are advantages and disadvantages to both techniques, according to individual patients and their conditions.

Some people with new hips return to a life they’d given up on. Johnny Bench says for years his love of golf was limited to a lumbering, painful nine holes. Other activities were out of the question. With all of his frequent travel, airports and flights were challenging. “After sitting in an airplane seat for a couple of hours, I’d be so stiff I had to get a cart to take me to baggage claim,” he admits. “What this surgery gives you — what it gave me — is a life you think is never possible again.”